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Modified pull-through coloanal anastomosis to avoid permanent stomas and reduce postoperative complications for lower rectal tumors

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We performed pull-through hand-sewn coloanal anastomosis immediately after sphincter-preserving ultralow anterior resection (ULAR) [pull-through ultra (PTU)] to avoid permanent stoma and reduce postoperative complications of lower rectal tumors. This study aimed to compare the clinical outcomes of PTU versus non-PTU (stapled or hand-sewn coloanal anastomosis with diverting stoma) after sphincter-preserving ULAR for lower rectal tumors.

Methods

This retrospective cohort study analyzed prospectively maintained data from 100 consecutive patients who underwent PTU (n = 29) or non-PTU (n = 71) after sphincter-preserving ULAR for rectal tumors between January 2011 and March 2023. In PTU, hand-sewn coloanal anastomosis was immediately performed using 16 stitches of 4–0 monofilament suture during primary surgery. The clinical outcomes were assessed. The primary outcomes were rates of permanent stomas and overall postoperative complications.

Results

The PTU group was significantly less likely to require a permanent stoma than the non-PTU group (P < 0.01). None of the patients in the PTU group required permanent stoma and the rate of overall complications was significantly lower in the PTU group (P = 0.01). The median operative time was comparable between the two groups (P = 0.33) but the median operative time during the second stage was significantly shorter in the PTU group (P < 0.01). The rates of anastomotic leakage and complications of Clavien–Dindo grade III were comparable between the two groups. Diverting ileostomy was performed in two patients with an anastomotic leak in the PTU group. The PTU group was significantly less likely to require a diverting ileostomy than those in the non-PTU group (P < 0.01). The composite length of hospital stay was significantly shorter in the PTU group (P < 0.01).

Conclusions

PTU via immediate coloanal anastomosis for lower rectal tumors is a safe alternative to the current sphincter-preserving ULAR with diverting ileostomy for patients who wish to avoid a stoma.

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Acknowledgements

We appreciate the contributions of all surgeons, coworkers, and friends involved in this study and thank the editors and reviewers for their help with this manuscript. We also thank Editage (www.editage.com) for the English language editing.

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Authors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima City, Kagoshima, 890-8520, Japan

    Shinichiro Mori, Kan Tanabe, Masumi Wada, Yuki Hamada, Ryutaro Yasudome, Tomohiro Sonoda, Daisuke Matsushita, Masataka Shimonosono, Takaaki Arigami, Ken Sasaki, Hiroshi Kurahara, Akihiro Nakajo & Takao Ohtsuka

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  1. Shinichiro Mori
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  2. Kan Tanabe
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  3. Masumi Wada
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Correspondence to Shinichiro Mori.

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Shinichiro Mori, Kan Tanabe, Masumi Wada, Yuki Hamada, Ryutaro Yasudome, Tomohiro Sonoda, Daisuke Matsushita, Masataka Shimonosono, Takaaki Arigami, Ken Sasaki, Hiroshi Kurahara, Akihiro Nakajo, Takao Ohtsuka have no conflicts of interest or financial ties to disclose.

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Supplementary Fig. S1

: Immediately performing hand-sewn coloanal anastomosis in the first stage. A A hand-sewn coloanal anastomosis between the colonic side wall and anal canal was immediately performed circumferentially. B Final view of the coloanal anastomosis following amputation of the prolapsed colon. (TIF 330 kb)

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Mori, S., Tanabe, K., Wada, M. et al. Modified pull-through coloanal anastomosis to avoid permanent stomas and reduce postoperative complications for lower rectal tumors. Surg Endosc 37, 6569–6576 (2023). https://doi.org/10.1007/s00464-023-10184-w

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